Ni Kadek Dwi Anjani

STRADA INTERNATIONAL CONFERENCE ON HEALTH
IIK STRADA INDONESIA

JL. Manila 37, Sumberece, Pesantren, Kota Kediri, Jawa Timur 64133, Indonesia
Telepon: (62) 822-3168-3185, Fax. (0354) 695130
www.iik-strada.ac.id
Mothers's Knowledge and Behavior of Anemia Prevention in Children:

Application of Pender's Health Promotion Model
Ni Kadek Dwi Anjani

1
Dr. Byba Melda Suhita,S.Kep.,Ns.,M.Kes (IIK STRADA,Indonesia)
2
Yenny Puspitasari,S.Kep.,Ns.,M.Kes (IIK STRADA, Indonesia)
nikadekdwianjani@gmail.com
ABSTRACT
Prevalence of anemia in children in Indonesia is still quite high. Parents' behavior in

preventing anemia in children is still lacking. Health promotion model (HPM) with a Pender's
model is needed. This study was aimed to develop a model of health promotion with a Pender
theory approach to maternal behavior on the prevention of childhood anemia. Quasi
Experiment with Pre and Post Test design was conducted in Kubutambahan II Primary
Health Care. Data was collected in 100 respondents and analyzed by Mc Nemar test. The
results showed there was an effect of health promotion on mother's knowledge of anemia
prevention (p = 0,000). There was no effect of health promotion on mother's attitudes of
anemia prevention (p = 0.845). There is an effect of health promotion on the actions/behavior
of mothers regarding the prevention of anemia in children (p = 0,000). The developing health
promotion based on the HPM approach can increase knowledge and behavior about
preventing anemia. Health promotion by conducting outreach to the community needs to be
carried out continuously by involving all aspects such as health workers, community leaders,
community health workers and families to improve community health status.
Keywords: anemia prevention. behavior, health promotion, knowledge
BACKGROUND:
Anemia is a blood disorder that occurs because the amount of healthy hemoglobin or
red blood cells in the body is less than normal. WHO data in the Worldwide Prevalence of
Anemia in 2008 showed that 48.8% of the world's population suffer from anemia. The
highest prevalence occurs in toddlers 47.4%, pregnant women 41.8%, while in school-age
children is 25.4%, which means 305 million school-age children worldwide suffer from
anemia (WHO, 2008). In Indonesia, prevalence of anemia in children under five is around
30-40% while in school children 25-35% is caused by poverty, malnutrition, vitamin A
deficiency and folic acid (WHO, 2008). Based on the results of the Basic Health Research in
2018, prevalence of anemia in Indonesia was 23.7%, and children aged 5-14 years were
26.8%, the fourth highest after what happened to the elderly, adolescents and toddlers
(Kemenkes RI, 2019).
Prevalence of anemia is quite high in school-age children due to improper eating habits,
irregular and adequate sources of nutrition needed by the body is not balanced. At this age
children have a high activity and a lot of energy expended to play and learn while eating
habits such as not having breakfast before leaving school, consumption of foods that contain
less iron is still often done (Kisworini & Mulatsih, 2005). Children's eating patterns are
usually influenced by friends in the school environment and the environment outside the
2nd STRADA INTERNATIONAL CONFERENCE ON HEALTH

Kediri, Indonesia, August 28-29, 2020 | 25
Telepon: (62) 822-3168-3185, Fax. (0354) 695130
home as well as the presence of advertisements or advertisements on television (Supartini,

2004). On the other hand, parents are often not aware of and not understand about anemia,
the causes and effects of anemia on children, some parents only know that anemia only
occurs in adults, so preventive measures for anemia in children are not done (Syah, 2007).
Increasing the ability of parents, especially mothers in preventing anemia in children with
education and counseling is one of the actions that can be done. It is hoped that parents'
knowledge and behavior in providing child food and children's eating patterns will be better
so that food intake, especially children's iron intake will be better too (Departemen Kesehatan
RI, 2007).
Health promotion with the Health Promotion Model (HPM) approach presented by Nola
J Pender is an effort to be able to help understand individual health behaviors and can be a
guideline in providing counseling to promote healthy behavior. In the theory explained
previous behavior, personal factors, the benefits of action, obstacles, self-ability, attitudes
associated with activities, interpersonal and situational influences and commitment greatly
affect one's behavior in achieving optimal health status (Pender, Murdaugh, & Parsons,
2002). This health promotion model has been used by a number of studies, one of which was
by Dian Laili Azizaa in 2014 which used lecture media and short films as an effort to prevent
diarrheal diseases. The results of this study indicate there is an influence between health
education lecture methods and short films on increasing student knowledge about diarrhea
prevention (Laili, 2014)
A preliminary study was conducted in the Kubutambahan II Primary Health Care for 25
children, from the results of the Hb examination as much as 8% (2 children) had anemia.
Observations were continued with 6 children in elementary schools in the local area, 3
children were found to be weak, lethargic, pale conjunctiva, sleepy and not concentrated
while studying, while 3 conjunctival children were not anemic, could focus while studying
and had good grades. The results of interviews with parents, most parents do not know about
anemia and do not know if anemia can be experienced by children. Providing health
promotion with the Health Promotion Model approach is expected to increase maternal
awareness and increase information in taking anemia prevention measures.
OBJECTIVE: This study aims to develop a health promotion model based on a Pender
theory approach to knowledge, attitudes and behaviors of mothers about preventing anemia in
children.
METHODS: This research was conducted in the Kubutambahan II Primary Health Care
using quasi experiment design and pre-post design approach. The study was conducted in
November-December 2019 to 100 mothers who have elementary school children aged 10-11
years. Pre and post data collection is done by using a questionnaire. Health promotion is
carried out by providing counseling 3 times a week for 3 weeks and then the analysis of data
is done using the Mc.Nemar Test. This study has received an Ethical Approval from the
STIKes Buleleng Health Research Ethics Commission with Number: 135 /EC-KEPK-SB /
X / 2019.

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RESULTS:
Description of Place of Study
Kubutambahan II Primary Health Care is located on Jalan Raya Singaraja-Kintamani,
Tamblang Village, Kubutambahan District, Buleleng Regency. The total population of the
Kubutambahan II Primary Health Care’s work area in 2018 was 15,165 males and 14,961
females with an area of 41 km2 consisting of 8 villages
Descriptive Public Data
Tabel 1. Distribution of characteristics respondents in Kubutambahan II Primary Health

Care, 2019
Characteristic Respondents ∑ %
Age 3 3
20-25 years 3 3
26-30 years 46 46
31-35 years 34 34
36-40 years 17 17
Education
Junior High School 16 16
Secondary High School 32 32
Senior High School and above 42 42
Status of working
Not working 55 55
Private employee 24 24
Government employee 3 3
Others 18 18
Parity
1 6 6
2 41 41
≥3 53 53
Children's age birth
10 years 59 59
11 years 41 41
Total 100 100
Source: Primary data
Characteristics of respondents can be seen in Table 1. Characteristics of respondents

seen by age, education, occupation, number of children and age of the child. The results
showed that some respondents (46%) were 36-40 years old, 37% had high school education,
55% of mothers did not work, 41% had 2 children, and 59% had children aged 10 years.
Table 2. Cross Tabulation between Variabel Dependen and Health Promotion in

Kubutambahan II Primary Health Care, 2019

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Pre Post
No Variabel
∑ (%) ∑ (%)
1 Knowledge
Good 56 (56%) 64 (64%)
Less 44 (44%) 36 (36%)
2 Attitude
Positive 45 (45%) 47 (47%)
Negative 55 (55%) 53 (53%)
3 Behavior
Good 50 (50%) 70 (70%)
Less 50 (50%) 30 (30%)
Based on Table 2. it can be seen that most of the respondents' knowledge before joining
the health promotion program is in the good category. Most of the respondents' knowledge
after health promotion was in the good category. Most of the respondents' attitudes before
joining the health promotion program were negative. Most of the respondents' attitudes after
internal health promotion were negative. Half of the respondents' behavior before joining the
health promotion program was in the good category. Most of the respondents' behavior
before joining the health promotion program was in the good category.
Table 3. Cross Tabulation between characteristic respondents and Pre Test in Kubutambahan
II Primary Health Care, 2019
Pre Test
Characteristic
No Knowledge Attitude Behavior
Respondents
Good Less Positive Negativ Good Less
1 Age
20-25 years 1 2 0 3 2 1
26-30 years 25 21 21 25 20 26
31-35 years 19 15 18 16 17 17
36-40 years 11 6 6 6 11 6
2 Education
Junior High School 3 13 2 14 8 8
Secondary High School 11 21 8 24 20 12
Senior High School and 42 10 35 17 22 30
above
3 Status of working
Not working 24 31 23 32 27 28
Private employee 21 3 16 8 10 14
Government employee 3 0 3 0 3 0
Others 8 10 3 15 10 8
4 Parity
1 5 1 3 3 3 3
2 27 14 26 15 19 22
≥3 24 29 16 37 28 25
5 Children's age birth

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10 years 26 20 29 32 33 31
11 years 30 24 16 23 17 19

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Table 4. Cross Tabulation between characteristic respondents and Post Test in

Kubutambahan II Primary Health Care, 2019
Post Test
Characteristic
No Knowledge Attitude Behavior
Respondents
Good Less Positive Negativ Good Less
1 Age
20-25 years 1 2 0 3 1 2
26-30 years 30 16 23 23 9 37
31-35 years 22 12 14 20 12 22
36-40 years 11 6 10 7 8 9
2 Education
Junior High School 5 11 2 14 3 13
Secondary High 14 18 16 16 11 21
School High School
Senior 44 7 29 23 16 36
and above
3 Status of working
Not working 29 26 21 34 14 41
Private employee 21 3 17 7 8 16
Government 3 0 3 0 3 0
employee
Others 11 7 6 12 5 13
4 Parity
1 6 0 3 3 2 4
2 29 12 22 19 10 31
≥3 29 24 22 31 18 35
5 Children's age birth
10 years 39 20 30 29 36 23
11 years 30 11 25 16 30 13
Table 3. and Table 4. shows the cross tabulation between respondent characteristics and
knowledge, attitude and behavior both before and after health promotion. Knowledge
improvement occurred in respondents aged 26-30 years and 31-35 years, at all levels of
education (junior high school, secondary high school, or senior high school), in mothers who
did not work and at all parities. Increased attitudes occurred in respondents aged 20-25 years,
26-30 years and 36-40 years, respondents who have secondary high school education and
respondents who have the number of children 2. While increased behavior experienced by
respondents in all age groups, all levels of education , also experienced by mothers who do
not work and private employees and all parity groups.

Telepon: (62) 822-3168-3185, Fax. (0354) 695130
Table 5. Application Pender's Health Promotion Model on Mother's Knowledge of Anemia

Prevention in Kubutambahan II Primary Health Care, 2019
Knowledge Pre Post
∑ % ∑ %
Good 56 56 64 64
Less 44 44 36 36
Total 100 100 100 100
Mc Nemar p=0,000
Based on Table 5. it was found that the majority (56%) of knowledge before getting
health promotion in the good category and the majority (64%) of respondents' knowledge
after getting health promotion in the good category. Based on the test with Mc Nemar, the
result p = 0,000 means that there is an effect of health promotion on respondents' knowledge
of anemia prevention.
Table 6. Application Pender's Health Promotion Model on Mother's Attitude of Anemia
Pre Post
Attitude
Σ % Σ %
Positive 45 45 47 47
Negative 55 55 53 53
Total 100 100 100 100
Mc Nemar p=0,845
Based on Table 6. it was found that the majority (45%) of respondents 'attitudes before
getting health promotion were in the positive category and the majority (47%) of respondents'
attitudes after getting health promotions were in the positive category. Based on the test with
Mc Nemar, the results showed that p = 0.845 means that there was no effect of health
promotion on the attitude of respondents regarding anemia prevention.
Table 7. Application Pender's Health Promotion Model on Mother's Behavior of Anemia
Behavior Pre Post
∑ % ∑ %
Good 50 50 70 70
Less 50 50 30 30
Total 100 100 100 100
Mc Nemar p=0,000
Based on Table 7. it was found that most (50%) of the behaviors before getting health
promotion were in the good category and the majority (70%) of the respondents' behavior
after getting health promotion was in the good category. Based on the test with Mc Nemar,
the result p = 0,000 means that there is an effect of health promotion on the behavior of
respondents regarding anemia prevention.

Telepon: (62) 822-3168-3185, Fax. (0354) 695130
DISCUSSION
Pender's Health Promotion Model On Mother's Knowledge
The results showed that there was an influence between health promotion and mother's
knowledge about preventing anemia in children. Provision of health promotion can increase
knowledge / information about the prevention of maternal anemia in children. This is
consistent with existing theories that knowledge is the result of knowing, which occurs after
people have sensed a particular object (Notoatmodjo, 2003). Knowledge is also the result of
remembering a thing, including recalling events that have been experienced either
intentionally or unintentionally and this happens after people make contact or observation of
a particular object (Mubarok, 2007). The purpose of health promotion activities is to increase
knowledge and attitudes about health so that it will facilitate the occurrence of healthy
behavior (Notoatmodjo, 2003).
The results of this study are consistent with research in Pekalongan about the effect of
interaction, knowledge and attitudes of mothers on the practice of preventing iron anemia in
infants, which shows the influence of knowledge and practice of preventing iron anemia in
infants. Research in Yogyakarta also found the same thing that there is an effect of anemia
health education in adolescent girls on anemia prevention knowledge (Kusuma, 2014). Other
research that also supports is research on the effect of health promotion on knowledge about
cervical cancer which shows that there is an influence between health promotion with
knowledge about cervical cancer (Saraswati, 2011).
Pender's Health Promotion Model On Mother's Attitude

The results showed that before health promotion was obtained some (45%) of
respondents had a positive attitude and as many as (55%) had a negative attitude and after
getting health promotion were obtained as many as (47%) respondents had a positive attitude
and a portion (53%) of respondents had an attitude negative. Statistical test results with Mc
Nemar obtained p = 0.845> 0.05 meaning that there is no influence between health promotion
on maternal attitudes in preventing anemia. The results of this study are not in accordance
with research in Surakarta about the effect of health education on the knowledge and attitudes
of pregnant women in consuming Fe tablets (Ferum) which indicate that there is an influence
of health education on mothers' attitudes in consuming Fe tablets (Astuti, 2012).
Factors that influence attitudes are internal factors: physiological (sick, hungry, thirsty),
psychological (interests and attention) and external motives and factors: experience, situation,
norms, obstacles and driving forces (Maulana, 2007). The attitude of the mother before being
given a health promotion found 45 respondents had a positive attitude and after being given a
health promotion only found 47 respondents who had a positive attitude. This may be due to
the cultural and cultural factors that already exist in each village in the Kubutambahan that
they only provide foods that are preferred by children without regard to nutritional status and
have no experience of children with anemia.
Pender's Health Promotion Model On Mother's Behavior

The results showed that before getting a health promotion it was found (50%) of
respondents had good behavior, and as many as (50%) of respondents had less knowledge,
after getting a health promotion it was found that most (70%) respondents had good
categories of behavior and a small portion (30%) of respondents have sufficient behavior.
Statistical test results with Mc Nemar found p = 0,000 <0.05 meaning that there is an
influence between health promotion on maternal behavior.

Telepon: (62) 822-3168-3185, Fax. (0354) 695130
This is in accordance with the theory of health promotion is a process to enable the
community to maintain and improve health (Notoatmodjo, 2003). The purpose of health
promotion activities is to increase knowledge and attitudes about health so that it will
facilitate healthy behavior (Maulana, 2007). In this study despite the negative attitude of the
respondents, the family always reminded about the benefits of anemia prevention and the
types of food needed by children to prevent anemia. The role of community health workers
also exemplifies the food that can be served to children to prevent anemia. Families and
cadres are also involved by always reminding respondents to maintain a healthy life even
though anemia has not yet occurred, motivating children to eat breakfast and want to
consume vegetables and cook in the right way so that the child's nutrition is optimally
fulfilled.
CONCLUSION: There is an effect of health promotion on mother's knowledge about

anemia prevention (p = 0,000), there is an effect of health promotion on mother's behavior
about anemia prevention (p = 0,000), there is no effect of health promotion on mother's
attitudes about anemia prevention (p = 0.845 ). Health promotion by conducting outreach to
the community needs to be carried out continuously by involving all aspects ranging from
health workers, community leaders, community health workers and families to improve
community health status
ACKNOWLEDGMENTS (if any): This research was conducted by researchers and

colleagues who worked at the Kubutambahan II Primary Health Care. As for the funding in
this study fully borne by researchers.
CONFLICTS OF INTEREST: There are several things that have not been studied by
researchers such as the development of models of interpersonal interactions between mothers,
families and health workers to improve maternal attitudes in preventing anemia in children,
given the importance of interactions between mothers and families in motivating mothers to
prevent anemia in children, and interaction between mothers and health workers in providing
information / education about the prevention of anemia in children.
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STRADA INTERNATIONAL CONFERENCE ON HEALTH

IIK STRADA INDONESIA

Mothers's Knowledge and Behavior of Anemia Prevention in Children:

Prevalence of anemia in children in Indonesia is still quite high. Parents' behavior in

Keywords: anemia prevention. behavior, health promotion, knowledge

2nd STRADA INTERNATIONAL CONFERENCE ON HEALTH

home as well as the presence of advertisements or advertisements on television (Supartini,

2nd STRADA INTERNATIONAL CONFERENCE ON HEALTH

Descriptive Public Data

Tabel 1. Distribution of characteristics respondents in Kubutambahan II Primary Health

Characteristics of respondents can be seen in Table 1. Characteristics of respondents

Table 2. Cross Tabulation between Variabel Dependen and Health Promotion in

2nd STRADA INTERNATIONAL CONFERENCE ON HEALTH

2nd STRADA INTERNATIONAL CONFERENCE ON HEALTH

Source: Primary data

2nd STRADA INTERNATIONAL CONFERENCE ON HEALTH

Table 4. Cross Tabulation between characteristic respondents and Post Test in

2nd STRADA INTERNATIONAL CONFERENCE ON HEALTH

Table 5. Application Pender's Health Promotion Model on Mother's Knowledge of Anemia

2nd STRADA INTERNATIONAL CONFERENCE ON HEALTH

Pender's Health Promotion Model On Mother's Attitude

Pender's Health Promotion Model On Mother's Behavior

2nd STRADA INTERNATIONAL CONFERENCE ON HEALTH

CONCLUSION: There is an effect of health promotion on mother's knowledge about

ACKNOWLEDGMENTS (if any): This research was conducted by researchers and

2nd STRADA INTERNATIONAL CONFERENCE ON HEALTH

2nd STRADA INTERNATIONAL CONFERENCE ON HEALTH

2nd STRADA INTERNATIONAL CONFERENCE ON HEALTH

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